Medicare Fraud


Book Description

MEDICARE FRAUD: Progress Made, but More Action Needed to Address Medicare Fraud, Waste, and Abuse




Medicare Fraud, Progress Made, But More Action Needed to Address Medicare Fraud, Waste and Abuse


Book Description

" GAO has designated Medicare as a high-risk program, in part because the program's size and complexity make it vulnerable to fraud, waste, and abuse. In 2013, Medicare financed health care services for approximately 51 million individuals at a cost of about $604 billion. The deceptive nature of fraud makes its extent in the Medicare program difficult to measure in a reliable way, but it is clear that fraud contributes to Medicare's fiscal problems. More broadly, in fiscal year 2013, CMS estimated that improper payments-some of which may be fraudulent-were almost $50 billion. This statement focuses on the progress made and important steps to be taken by CMS and its program integrity contractors to reduce fraud in Medicare. These contractors perform functions such as screening and enrolling providers, detecting and investigating potential fraud, and identifying improper payments and vulnerabilities that could lead to payment errors. This statement is based on relevant GAO products and recommendations issued from 2004 through 2014 using a variety of methodologies. In April 2014, GAO also received updated information from CMS on its actions related to the laws, regulations, and guidance discussed in this statement. Additionally, GAO updated information by examining public documents and relevant policies"







Medicare Program Integrity


Book Description




Crossing the Global Quality Chasm


Book Description

In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.




Health Care Fraud and Abuse


Book Description

Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.




Standards for Internal Control in the Federal Government


Book Description

Policymakers and program managers are continually seeking ways to improve accountability in achieving an entity's mission. A key factor in improving accountability in achieving an entity's mission is to implement an effective internal control system. An effective internal control system helps an entity adapt to shifting environments, evolving demands, changing risks, and new priorities. As programs change and entities strive to improve operational processes and implement new technology, management continually evaluates its internal control system so that it is effective and updated when necessary. Section 3512 (c) and (d) of Title 31 of the United States Code (commonly known as the Federal Managers' Financial Integrity Act (FMFIA)) requires the Comptroller General to issue standards for internal control in the federal government.




Public Policy


Book Description

"Kraft and Furlong provide students with a conceptual understanding of public issues and how the public policy process functions. This book also provides a forum for discussions of social, economic, and sustainable development issues; their characteristics; and impacts on human beings (citizens) as well as the environment. It will give students the needed tools to make informed economic and human development decisions that could lead to sustainable growth, human capacity building, and better lives." —Robert Dibie, Indiana University Kokomo With the right information, we can develop public policies that work better. All too often, public policy textbooks offer a basic grounding in the policy process without the benefit of integrating the use of policy analysis. Kraft and Furlong take a different tack. Public Policy: Politics, Analysis, and Alternatives, Seventh Edition helps students understand how and why policy analysis is used to assess policy alternatives. The text encourages them to not only question the assumptions of policy analysts, but also recognize how these strategies are used in the support of political arguments. The authors introduce and fully integrate an evaluative approach to policy to encourage critical and creative thinking on issues ranging from health care to climate change. From a concise review of institutions, policy actors, and major theoretical models to a discussion of the nature of policy analysis and its practice, Kraft and Furlong show students how to employ evaluative criteria in six substantive policy areas. Students come away with the analytic tools they need to understand that the motivations of policy actors—both within and outside of government—influence a complex yet comprehensible policy agenda. A Complete Teaching & Learning Package LMS Cartridge (formally known as SAGE Coursepacks) Import this title’s instructor resources into your school’s learning management system (LMS) and save time. Don’t use an LMS? You can still access all of the same online resources for this title via the password-protected Instructor Resource Site.




Geriatric Anesthesiology


Book Description

Surgical and anesthetic techniques have evolved to allow a growing number of older adults to undergo surgery, and current estimates are that 50% of Americans over the age of 65 years old will have an operation. However, as the knowledge regarding perioperative care of the elderly surgical patient grows, so do the questions. In this edition, each chapter includes a section entitled “Gaps in Our Knowledge,” meant to highlight areas in which research is needed, as well as hopefully inspire readers to begin solving some of these questions themselves. Building upon the strong foundation of the first two editions, Geriatric Anesthesiology, 3rd edition also assembles the most up-to-date information in geriatric anesthesia and provides anesthesiologists with important new developments.Topics covered include several new chapters that reflect the evolution of multidisciplinary geriatric care throughout the perioperative continuum, as well as the growing body of literature related to prehabilitation. In addition, discussion of the surgeon’s perspective and geriatrician’s perspective on surgery in the geriatric population is covered, as well as the systematic physiologic changes associated with aging and the pharmacologic considerations for the geriatric patient undergoing procedures. Finally, the last section discusses postoperative care specific to the geriatric population, including acute pain management, ICU management, recent evidence and up-to-date practice regarding delirium and postoperative cognitive dysfunction, and palliative care.




The Medicare Handbook


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